Hi Guys,

I like the new and improved nozzle, and pulse duration that reduces the amount of charring–to ZERO!

I also like the CO2 better than diode in this application since the zone of thermal injury is so small with the CO2 as compared to the near-IR diodes. Much more comfortable to the patient.

Take a look at the imperceptible zone of coagulation or blanching–there is none! Very nice. Yet this was sufficient to remove tissue and not create blood flow. Very impressive.

Now as far as perio goes, a nozzle tip and a “free-beam” wavelength when placed down into the perio pocket 8-20mm as we do with our LANAP protocol, if it can reach those depths, will get clogged as did the old Luxar CO2.

The CO2 wavelength–as is shown by the cut on the gingiva–is well absorbed into connective tissue. That’s NOT something I want when treating the perio pocket.

With pulsed FR near IR, we can histologically dissect the epithelium off the Rete Ridges of CT and not injure them so they can assist in New Attachment. No can do with far IR.

I’m still waiting for Dr Justin to produce a single piece of literature that shows the safety and efficacy of using short pulsed CO2 with a nozzle delivery system inside and blind in a perio pocket. Since he first showed up on the scene at ALD he has not produced a single studie after several requests from me and others.

Maybe his new found researcher in Missouri will help to do so?

Over the last 14 years, my pulsed Nd:YAG friends and I have been scolded, berated, sued, slugged, called names like “delusional” and a few other because we dared to suggest we could use a near IR laser fiber to treat gum disease and regenerate lost attachment because we didn’t have any data to support it.

Now that we have data–and a new FDA clearance for our patented protocol Laser ANAP–our critics now insist on “pure and perfect science” whatever that is.

All I am asking is that those who suggest their device is something that dentists might use in the perio pocket have, at a minimum, is some of the same science that we built our concepts upon 12 and 14 years ago that suggested to us it was safe to use our near IR lasers in the perio pocket. (Midda, Gold, White, Moritz, Whitters, Horton, etc)

As those who know me can attest, I will never be anything like the mean-spirited, demeaning, disrespectful, and threatening individuals who–to this day–attack, disparage, and ridicule MDT, the PerioLase, LANAP and me and Del personally. But I will, politely, persistently, patiently, professionally ask those who advocate a laser device in the perio pocket to produce some evidence that their device is:

1. Safe for patients
2. Does not injure periodontal structures and root surface.
2. Effective in reducing pocket depth and clinical attachment level
3. Reproducible from doctor to doctor–that suggests a well established clinical protocol.
4. Predictable results from patient to patient–not just a few isolated cases.
5. Human histology to demonstrate the nature of the healing–“repair” by long junctional epithelium, or “regeneration” by new cementum, PDL, and bone.

Yeah, I know its a high standard that we have set. It was insisted upon by those who wanted to dismiss us and our results–they keep moving the standards higher every time we reach one of their milestones. Well, now those milestones are landmarks and it will be tough on those who follow, as well as those who wanted us to fail.

So it isn’t good enough to claim, “We can do what the PerioLase can do”, because the PerioLase MVP7 supports a protocol. In fact , we designed the PerioLase MVP-7 after we designed, tested, and studied the protocol–not the other way around. It’s the protocol that gets the results, but w/o the right device, everything breaks down–literally.

It’s like chocolate chips. Which is the critical ingredient? The brown sugar or the chocolate chips? A recipe for a successful result is the byproduct of a well tested selection of the proper ingredients combined in and at the right time to achieve the final results. You cheat on the quality of the ingredients and you know what you get………

Dr Justin and all the others–complete your device and protocol testing, then put them both to a test of impartial science. Then we can talk about comparisons.

Sorry for the rant. Now back to your regular scheduled programming…………..

All the best,

Bob

Bob-
Well said, as usual. Of course I am in your camp, so I guess I may be biased? I seem to be hearing more interest from periodontists for CO2 over mvp-7 for some strange reason. Haven’t figured that one out yet, considering the science doen’t back it.

The difference bewteen a boat and a car.

Both are vehicles and will transport you–just differently.

Where do you want to go? What you you want yo do?

What kind of Nd:YAG do you have–some are “out-of-date” to say the least?

Bob

Advice?

Sure.

If you want to remove large volumes of tissues like dylantin or cyclosporin overgrowth–a CO2 comes in very handy. It has other applications like the other laser devices like frenectomies, fibroma removal, vestibuloplasties, but no hard tissue capabilties like the erbium family of lasers.

Diode are dedicated soft tissue lasers.

Pulsed Nd:YAG of today’s reincarnation have both hard and soft tissue applications (no enamel removal though like erbium), but with variable pulse durations (a feature the early Nd:YAGs did not have) there is much better hemostatic control. These are ideal for periodontal disease treatment.

So what is your clinical challenge? Lots of Pedo? Try an erbium/diode combo.

Lots of perio? Try a FRP Nd:YAG with variable pulse durations.

Any better help?

Bob

Dear E,

I agree with your overall assessment.

Here’s my Cliff Notes on the question:

CO2:

1.  Is highly absorbed in water and hydroxapatite
2.  All tissues with water and HA will absorb CO2
3.  No tissue selectivity
4.  Is not fiberoptically delivered–access is a big problem in the posterior of the mouth.

FRP Nd:YAG

1.  Is transparent through water (no absorption)
2.  Absorbed in pigments in tissue to varying degree based on absorption profiles.
3.  Is delivered through quartz glass fiber optics–therefore the cannot “clog” like the small nozzles on CO2.
4.  Has tissue selectivity–that is the wavelenth will transmitt through tissue w/o effect until the beam encounters a pigmented protein or something else.

CO2 cannot do what Nd:YAG can do.  Nd:YAG cannot do what CO2 can do.

Why do engineers, PhD salesmen continue to insist, “our laser can do it all?”  Cuz they designed and built their “box” before doing the clinical applications studies first.  Most of the failed laser companies have built a laser then gone out to make claims their laser can do it all.  We are seeing a resurgence of that none sense with CO2 recently.

There is no one single laser that can all things equally well.

There is no color that goes with everything–except black, which is comprised of all colors of the rainbow.

So we wouldn’t want to use a blue laser to selectively remove port wine stain or hemangiomas.  We would want the complimentary wavelength of red which is green to remove ONLY the red capillary tissues and leave the surrounding tisues unharmed (unless over heated by conduction)

If you used a CO2, you would non-selectively vaporize the red capillaries and a whole lot of surrounding tissue since the red capillary and the surrounding tissue all look “black” to the CO2 wavelength and would destroy them equally.

I know no one who advocates the CO2 as the most versitile have actually used the newest generation of variable pulsed Nd:YAG lasers in a clinical setting.

Most advocates have used one or the other exclusively to arrive at their preferences.  I have used most if not all laser devices that have been promoted as being the “one and only”.

I think the most versitile is FRP Nd:YAG and I have used CO2 and all the rest…….

Hope that helps!

Bob

Dear E,

Probably we should have this discussion in the diode section.

What sort of soft tissue applications are you interested in?

Are you registered on Dental Town? I think there is quite a lot of diode FRP NdYAG discussions there, and some here as well.

http://www.rwebstudio.com/cgi-bin/ikonboard//topic.cgi?forum=30&topic=21

http://www.rwebstudio.com/cgi-bin/ikonboard//topic.cgi?forum=30&topic=20

Bob